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77 Cards in this Set
- Front
- Back
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What does the AANA Infection Control Guide state?
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Every CRNA & employer must meet or exceed the standards & rules promulgated by OSHA & EPA to protect healthcare workers.
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Infection control includes the flowing topics....
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AANA Infection Control Guide
OSHA Guidelines HBV and HCV CDC Guidelines Risk Classification System Decontamination Plan Anesthesia Machine Biohazardous Waste AANA Article |
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What standard specification prevails when more then one standard is applied to an issue of safety or performance within a jurisdiction?
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Whenever more than one standard applied to any issue of performance and safety within any given jurisdiction, the highest standard specification prevails.
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What are the goals of the Occupational Exposure to Blood borne Pathogens an
OSHA standards document issued 12/6/91 ? |
Eliminate or minimize occupational exposure to HBV, HIV, and other blood borne pathogens
Employers required to provide PPE, Hep B vaccines, work practice controls, medical surveillance signs/labels, annual training Violations carry fines up to $70,000 with each occurrence |
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Should the practice of HIV and Hepatitis infected health care workers be restricted?
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HIV alone does not justify imposing limits on professional duties
unless other factors compromise his/her ability to perform work Evaluate on case by case basis |
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What are the 6 factors that would compromise an HIV or hepatitis infected healthcare worker from doing their job? (6)
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An illness that may interfere significantly with the CRNAs ability to provide quality care – assess both physical and mental competence.
Immunologic status and susceptibility to infectious diseases. Presence of exudative lesions. Functional inability to performed assigned tasks and regular duties. Documentation or evidence of previous transmission to patient of blood borne pathogens, including HBV. Noncompliance with established guidelines preventing disease transmission. |
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How many PEOPLE die per year from chronic liver disease due to Hepatitis B infection?
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4000 to 5000 people die per year
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How many HEALTHCARE WORKERS die per year from Hepatitis B?
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Approximately 250 healthcare workers
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What is of greater likely hood for nonimunized healthcare workers to contract Hepatitis or HIV?
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Total number of carriers in US estimated to be 800,000! The likelihood of nonimmunized health care workers developing hepatitis from contact with infected body fluids is much higher than that for HIV.
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What percentage of people serioconvert after HEPATITIS B needlestick?
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30%-40% seroconversion after needlestick (robust virus)
Remains viable on needles, surfaces and gloves up to 14 days |
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What percentage of anesthesia personnel have seriologic markers?
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15-50%of anesthesia personnel have serologic markers
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What percentage of anesthesia personnel have acute hepatitis B, what is the mortality?
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1% - acute hepatitis B (60% mortality)
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What percentage of anesthesia personel have chronic hepatitis B?
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<5% - chronic hepatitis B
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What variant of Hepatitis is Vaccine perventable?
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B
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What percentage of Hepatitis C exposures seroconversion after needlestick?
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3% seroconversion after needlestick
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What percentage have chronic hepatitis C?
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85% - chronic hepatitis
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What percentage of Hepatitis C have Cirrhosis?
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20% - cirrhosis
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What percentage of hepatitis C have Liver CA?
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3% - liver CA
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What is a major cause of non-A-non-B hepatitis?
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Hepatitis C
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In the OR what method of infectious disease control is not available?
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In OR hand washing with soap and water is not available
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What must the employer provide in leu of soap and water for hand washing?
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employer must provide microbial or waterless antiseptic agents located within arm’s reach of provider.
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CDC 1995 Guidelines for Isolation Precautions in Hospitals
consists of how many teirs? |
2
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What does Tier One consist of in the Guidelines for Isolation precautions?
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Major features of Universal Precautions and Body Substance Isolation
Designed for care of all patients Mandatory compliance Assume all blood/body fluids potentially infectious Hand washing PPE Needle disposal |
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Who do you use Tier One guidlines for isolation on? Is it optional?
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Designed for care of all patients
Mandatory compliance Assume all blood/body fluids potentially infectious |
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What does Teir 2 consist of in the Guidelines for Isolation precautions?
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Tier II Transmission Based Precautions (Airborne)
Used in addition to standard precautions |
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How do you protect against tier 2 Airborne Pathogens?
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Use properly fitted mask with high efficiency filtration
Use disposable equipment when possible PPE includes gloves, mask and eye wear |
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What are are four types of Airborne Pathogens?
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Measles, varicella, TB, MDR-TB
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What is the biologic description of a Tier 2 Microorganism (airborne)?
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Microorganisms < 5 micrometers
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What is the biologic description of a droplet?
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> 5 micrometers
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What are four types of Tier 2 droplet Pathogens?
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Influenza
Mumps Rubella Strep-pneumonia |
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Droplet Precautions
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Mask should be worn within 3 ft of patient
Eye protection for laryngoscopy |
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Contact Precautions
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Were also released in CDC 1995 Guidelines for Isolation Precautions in Hospitals
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What diseases are contact precautions used in?
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MRSA
VRE impetigo herpes simplex viral/hemorrhagic conjunctivitis |
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How do you perform Contact Precautions?
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Gloves used in patient contact
Removal of gloves and hand washing after contact Use care not to contaminate anesthesia equipment with gloves |
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Name the 4 of the classification system of the risks of transmitting Infection s?
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Critical
Semi-critical Noncritical Environmental |
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What defines Critical infection risk?
Give examples |
Items entering sterile area of body or vascular system
IV catheters, regional equipment |
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What defines Semi-critical infection risk?
What is the level of disinfection? Give examples |
Contact with mucous membranes
Sterile or high level disinfection Laryngoscope blades, macgill forceps, breathing circuits, masks |
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What defines noncritical infection risk?
What is the level of disinfection? Give examples |
Items not contacting patient or contacting intact skin
Intermediate to low level disinfection NIBP cuffs, skin temp probe, ECG cable, pulse oximeter |
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Environmental risk required what level of disinfection?
give examples of items? |
Intermediate to low level disinfection
Eqpt and cart surfaces, knobs, handles, floor |
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How many steps exist to the Decontamination Plan?
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3
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Step 1 in the decontamination plan consists of what?
This is appropriate for what risk? |
Detergent and H20 (low level)
Appropriate for environmental risks |
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What does Step 2 in the decontamination plan consist of?
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Step 1
and Disinfection with chemical germicide |
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What chemical germicides are used in Step 2 of the Decontamination Plan?
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intermediate level
Cidex Sodium hypochlorite |
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What does Cidex kill?
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kills bacteria, viruses, spores
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What does Sodium hypochlorite kill?
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kills bacteria
viruses |
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Step III consists of ?
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Step 1, 2 and sterilization
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How can sterilization be achieved?
(3 methods) |
Steam autoclave, ETHYLENE OXIDE and radiation
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What is killed by step 3 of the decontamination plan?
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viruses
spores |
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What requires sterilization on the anesthesia machine?
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Generally, components between common gas outlet and patient require sterilization
These are typically disposable with each case |
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All other components and surfaces of the anesthesia machine require what level of disinfection?
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High level disinfection
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What components consist of the patient circuit? (5)
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Includes all components directly communicating with patient’s respiratory system
CO2 absorber, canisters, inhalation-exhalation check valves, APL valve, ventilator bellows |
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Absorber and canisters of the patient circuit require what treatment?
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replaced, cleaned or sterilized
as needed on regular basis |
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What is recommended for the Y connector and the corrugated breathing circuit?
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Bacterial filter recommended
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APL, check valve domes, discs need to what treatment?
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cleaned, sterilized according to manufacturer
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The ventilator system should be sterilized after every case unless what is used?
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bacterial filters used to protect inspiratory, expiratory and ventilator limbs of circuit
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Where is a single use bacterial filter placed?
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Between y-piece and mask and/or expiratory limb
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What must be done to the sample line while using the single use bacterial filter?
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Sample line must be protected by filter or be disposable
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What may or may not be incorporated in the Heat-moisture exchanger?
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bacterial filter
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What 2 thing should be done to heated humidifiers after use?
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Cleaned
sterilized |
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The waste gas scavenging system must be sterilized after an infected patient unless what device is used?
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bacterial filter
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Work surfaces require?
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Routine cleaning, disinfection
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Monitors
Stethoscopes, pulse ox, cuff, ECG leads, precordial require? |
Routine cleaning, disinfection
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Biohazardous Waste is considered?
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Liquid or semi-liquid blood or potentially infectious materials
Items caked with dried blood and are capable of releasing these materials during handling Contaminated sharps Pathological/microbiological wastes containing blood or other infectious materials |
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What do standard precautions assume?
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that all patients are potentially infectious
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How are anesthesia providers are to approach risk, transmission and cross contamination of infection?
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in a careful, consistent and logical manner
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Standard precautions are considered what?
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non negotiable
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Prevalence of Visible and/or Occult Blood on Anesthesia and Monitoring Equipment. AANA Journal
attempted to determine what? |
“Purpose of present study was to determine the prevalence of visible and/or occult blood on anesthesia equipment and monitoring equipment identified as ready for use.”
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Where was data collected in the
Visible and/or Occult Blood on Anesthesia and Monitoring Equipment study? |
Data collected from 2 hospitals
One civilian, one military 28 OR’s examined for 336 samples |
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What surfaces and items were tested?
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vent control knobs, switches, flow meter knobs, vaporizer dials, ECG cables, pulse ox, BP cuff
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What 2 methods were used to determine the prevalence of visible and or occult blood on anesthesia monitoring equipment?
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Visual inspection
wiped with alcohol swab to be tested for occult blood |
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What was determined by the visible and or occult blood on the anesthesia monitoring equipment study?
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Neither facility had written guidelines for specifically cleaning or disinfecting this equipment between cases
Staff members reported “looking at the equipment and cleaning it if it was dirty” Responsibility for cleaning was shared by OR nurses, techs, housekeeping |
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What is not a reliable means of determining if it needs decontamination?
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Visual inspection of equipment
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How can you avoid contamination immediately after intubation?
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Double glove
Remove gloves before touching any part of work environment |
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Use gloves when placing any other equipment
give examples |
Esophageal, nasogastric tube
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When do CRNA's need to wash hands?
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removing gloves (in OR with waterless) and as soon as possible after case or leaving OR with detergent and H20
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Always do what to the equipment between cases?
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Clean and disinfect
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Why did ECG cables had highest percentage of positive visible or occult results (53-81%)?
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Usually dropped on floor after procedure which is contaminated with blood
Due to design, blood or contaminants can easily adhere to surface |
